I so respect your videos and your balanced approach to discussing the traditional Medicare w/ a supplement plan vs Medicare Advantage plans. I have referred others to your videos when they have to make the choice between the two. I'm fortunate enough to be able to afford a supplement plan. I love knowing the absolute certainty of what is covered and not worrying every year about the annual changes that can and do occur with an Advantage plan. IN MY OPINION, a person doesn't have to be as clever as a fox to know, if you desire "peace of mind" now and in the future, surrounding not being denied admission into a hospital of my choice and finding out in the future that speciality places like the Mayo Clinic will not accept Advantage plans, getting a supplement plan would be the way to go. Thank you . :-)
I agree with you. For people who can afford a supplement plan and value the freedom that route offers, it is the way to go. Appreciate you spending time with me and sharing these with your friends
I’m on a supplement plan because I live in 2 states and want no network limitations. (I haven’t figured out how to weave fox into my comment). While I am biased towards supplement plans I am quite impressed on the excellent care my brother in law is getting for brain cancer treatment in Florida from his Advantage plan. Your analysis was very helpful.
Thank you so much for sharing your thoughts and logic 🦊 Ya, I hope it doesn't come off as me trying to convince people to switch. Much more about those already on an advantage plan understand how it works and navigate the messages they may be hearing out there. Appreciate you!
Thank you very much! I've been on an Advantage Plan since I went on Medicare, and I love it! Never been denied any services, all my drugs are covered, I see the doctors I want to see. When I had back surgery back in 2017, my out-of-pocket was around $1K. I've never come any near the deductible. I live in VT and there is a minimal premium, but for what i get, absolutely no complaints! FOX!
Thank you so much for watching and sharing your experience! Vermont is beautiful! Did you see the Vermont video we did? :) ua-cam.com/video/Ny6LfpPn0xE/v-deo.html
When you showed the page with the health care companies/systems not accepting certain companies/only accepting certain companies/not accepting any companies, it made me realize how bad MA plans are. We have had Humana MA for several years, but the very, very large medical system in our area may not accept Humana MA plans starting in April 2025. If this happens, and it may (especially seeing that page), we then become very limited in our medical options without going out-of-network. Since this has not been resolved, we could not possibly stay with Humana. Actually, we view this as an opportunity to get on a Medicare supplement plan and get away from MA plans.
Eric - thank you sooo much for the invaluable service you provide to those of us newer to Medicare. I’m glad you are doing this full time because so few people provide this information and balanced presentation, with a focus on real data. You are a fox. It this age of social media, I’m sure you have get some, maybe a lot of negative feedback, but you are doing a great job. I’ve watched many of your videos and have learned a great deal. These are critical decisions for retirees and having unbiased, well informed information and guidance is rare. Keep up the great work! Much appreciated.
Appreciate you saying this 🦊 There is a lot of negativity that gets tough to balance sometimes, but comments like yours make it all worth it. Being able to do UA-cam full time also helps eliminate any appearance of bias or conflict. There wasn't any before, but now there shouldn't even be any inkling of possibility there. Thank you!!
Hi Eric, thanks for these videos of interest. I guess it's safe to say that Advantage plans are great depending on where you live. I for one, am in Fort Worth Texas, and my Advantage plan has an unbelievable number of Primary care and Specialist Doctors, and at least 8 hospitals within a 10 mile radius. I have also done some research, I have called a few clinics and hospitals in network to make sure my plan is still accepted. And what I like most about my plan, is the preventative care. My Doctor performs labs and test to ensure my health is as it should be. Overall, I am very pleased with my Advantage plan.
Thank you so much for sharing this my friend! Always appreciate your comments. Yes... where someone lives is (in my opinion) the single most important determining factor in this decision.
I am so thankful for your videos as I feel they provide me with factual information, pointing me in the right direction for research in making good solid choices for our life. You are like a fox in your presentation and work. I have recently heard about some advantage plans leaving the network, so I will be checking out your next video on this subject and may be in search for an agent to assist. Thank you for your work.
Here is my fox. A necessary statistic for denial is how much claim money was denied for the patients where it shouldn't have been denied. The reason is that they can still look good statistically on claims but maybe not on the amount of money of claims denied. Obviously, the amount is more catastrophic for a patient. A business can look at the statistics being used and then do things to make those not look too bad but when you dig deeper there might be a problem. Please note, I am not saying there is a problem. I just feel that the statistics used might not show the full picture either way. 🙂
Completely agree! One thing that is so hard with this industry is the availability of reliable data... and then... more granular breakdowns of that. Like the 1st study, I think the conclusions aren't really statistically solid. The 2nd study just looks at everything and doesn't try to draw conclusions as much as just point out the numbers. Hard to know the full picture with millions and millions of claims and experiences :) Appreciate you!
Thank you, Erik. You are doing a great job educating us! I am learning so much from you. Don't let the agitators get to you, just ignore them and sneak past them like a Fox.
@@Theretirementnerds I can imagine how discouraging and hurtful it would be to be attacked so ruthlessly when you are in the public eye in the way that you are. People feel free to be so vocal and make accusations without any evidence. It seems to be the time we are living in. I will continue to enjoy and appreciate everything you do to educate us about all thing’s retirement. Thank you for all you do!
Fox in the hen house. Haven't heard that since I was a Yonker. As for Advantage plans I do not see how they differ from my employer health plan. I have to use the network and even then can be denied payment. I pay copay, deductibles, and have a MOOP. The insurance decides what medications I can get and requires a mail service pharmacy. Not really sure I would notice a difference personally.
My PCP just left the network to go to a concierge service. There are no new patient openings with the remaining doctors. Being on Medicare instead of Advantage, I can find a new doctor outside of that network, although it is a hassle since ancillary services are in that network. Advantage plan members will have to switch networks or travel some distance to find a doctor.
My PCP did the same (he waited until his kids graduated from college), I don't blame him. My Advantage plan guarantees I will have a PCP, so when I couldn't find one, one of the (two) huge hospital chains in my Advantage plan's network found me four to choose from. Two are within 10 miles of my home, two are at the hospital I go to.
Red fox, Grey fox how do you discern the difference? So easy to be fooled. As always your information clears up the difference! Keep up the great work for all us retired nerds
We have a Fox that plays in the field by our house. I love the way you explain things down to the finest detail with the time allowed in your videos. I was told recently that BCBS is pulling out of the Kansas City market for advantage plans. I was also told that Aetna (my current provider) has lost it's ability to contract with North Kansas City Hospital. While that doesn't have an affect on my health provider it does raise a question. If I'm entered into a contract with an insurance company for 1 year, yet their contract with a hospital falls through, why shouldn't the insurance company be required to fulfill my needs to the end of my annual term? I'm not provided the ability to change insurance companies in the middle of the year, so why are insurance companies allowed to make such a drastic change in the middle of the year?
I agree with you on this one. I recorded a video today about advantage plans leaving markets. Hoping to edit that and get it out soon. With the plan leaving the market, people actually have more flexibility and freedom than if my plan just changed negatively. I like the idea of being able to switch plans if a provider contract ends. Won't ever happen, but I like the concept of it.
@@Theretirementnerds I just watched the newest video you mentioned and it looks like I'm going to have an interesting visit with my broker. Thanks for what you do.
Fox. Hearing about a 92 year old who fell during a blizzard and needed immediate surgery have to go through pre authorization up to three days is enough of a turnoff. The other one I hear about is chemotherapy co-pays. I can afford plan g and avoid potential trouble.
That time between receiving the prior authorization and approving is something I have issue with as well. Here is a video on cancer treatment on both: ua-cam.com/video/77YF-TL0n-8/v-deo.html 🦊
Thank you Eric for another wonderful and very honest video. You are as sly as a fox, never giving your opinion as to which plan a person should buy. This video was the comfort that I really needed in helping me in deciding to go with a Medicare Advantage plan for 2025. This summer, when you passed through my state of Nevada, you mentioned that we have some of the best plans in the entire country and anyone who lives in Las Vegas should actually take an honest look at them. For the last few months, I have been doing my homework and decided to drop my supplement plan, which has been costing me a fortune, and I have never used. For 35 years I have had a plan similar to Medicare Advantage in the workplace and it worked absolutely fine for me. Although only God knows the future for our health, I think everyone is different and each one should make a decision as to what is right for them. I have friends a lot older than me who have always been on Medicare Advantage and have never had any problem with it. I will definitely try it for one year and utilize my “trial right #2,” knowing that if it doesn’t work out, I can go back to my supplement plan. Thank you for all of the wonderful knowledge that you have given us!
Appreciate you and your support! Definitely not trying to persuade anyone one way or the other here 🙂 Just trying to show how they work. Really wish we could've connected when we passed through. I blame myself! 🦊
I have been doing the same as you, researching like crazy to determine if an Advantage plan is a better option for my husband and I. Although we can afford our supplement plan N premiums, drug costs, dental and vision out of pocket, I see the value in having an Advantage plan with these benefits included at no extra cost. It was my 2025 part D drug ANOC that prompted the research on Advantage plans. But then I watched several YT videos with the scare tactics that Eric mentioned, that I will surely die at the hands of the evil insurance companies, and then I think I should just remain with my current Plan N. This video has put me at ease that I’m not crazy to consider a switch for at least a year. We live in a large urban area in Texas and from what I have found the networks are very large. Eric pointed out that where you live is a major determinant in your decision and I find this to be true. I also will be able to exercise my 2nd trial right to be able to switch back to my Plan N if I find that Advantage isn’t for me. Wonderful and informative video, Eric!
Thanks, ERIC for the “foxy” well crafted comments back by accredited documentation breath of fresh air as we try to navigate our way through an overly complicated system being thrust on our seniors.
I value the education you provide. I thought to myself I would like to do business with this firm, however, I am confused as I heard you say at the end your video, your revenue stream is through educating others through UA-cam. You referenced Brokers as peers, which you value their knowledge, and they have your trust, but who do they work for? Do you provide oversight over them or just have a good relationship to "feel" they will do the right thing for the customer. Could you provide more clarity of the working model? I am not sure how I will get notified when or if you post a video that explains your model, but I am really interested. I suppose I am one of those old foxes who couldn't chase a chicken if I wanted to, but if there is anyone I do business with that would be you. Thanks again for everything you do. You are AWESOME!!!!
Appreciate you watching and your kind words! Happy to explain in more detail. Email is probably better than the UA-cam comment section :) My email is erik@theretirementnerds.com if you'd like to connect.
I’m sticking to my Original Medicare plan g supplement for now, but I’ll continue to keep an eye on the how MA part C plans in my area respond to all these changes. Recently I did get a friend having trouble with a MA plan to work with an agent to use my state’s birthday rules to change to a better insurance company. Recently we have had a resurgence of native species foxes 🦊 over the invasive kind in the regional parks near me.
Thank you so much for watching! Definitely not trying to persuade anyone away from the supplement plans :) Love, LOVE supplement plans. More just trying to help those already on an advantage plan deal with what they are seeing/hearing. Appreciate you! Love seeing your comments and your support! 🦊
Another great, informative, data driven video. Thanks. My wife and I have been on various Advantage Plans for 8 years. Over those years we have had several surgeries and hospital stays with no problems related to prior authorizations and networks. The Advantage Plans have worked well for us. In 2025 we are both planning on moving to Medicare + Supplement (HDG) since we will be splitting our time between Utah and New York (our current state of residence). I plan on calling your office to get the contact info for your NY State partner so that I can discuss the best path forward. Thanks again.
Thankfully you didn't push the Fox channel!! Loved your video. I have a supplement (G). My wife has AARP (UHC) Advantage. Unfortunately, they've been going through dealing with the local hospital systems (Duke and UNC) and have had issues. So far, negotiations have worked but you never can be sure. I have too many health issues to take the chance so I am keeping my supplement even though my agent thinks I should switch. So, my question is, do the agents make more off the advantage plans or the supplements? It sure seems to me that it should be the supplement. Just curious.
Thank you for watching! 🦊 Yes, agents will typically make more in 1st year commissions on advantage plans than supplement plans. We have a lot of videos about this and where we stand on that topic, but yes, advantage plan commissions are regulated by the federal government and are higher. Supplement plan commissions are not regulated by the federal government are typically not the same as advantage plan commissions.
Thanks Erik! We have foxes around here, but we also are careful with the weasels. We need to keep the chicks safe. Your information and keeping us updated with the facts is appreciated.
It breaks my heart certain agents will put people in these plans without a full breakdown of what could go wrong. All health insurance has risks; but many sell these only talking about freebie perks. Thank you for spreading the word and educating people
Agreed! Our take: Inform the person about pros and cons of both as close to the reality as possible without fear-mongering or the perks... ugh... the perks. Hospital and Medical coverage and access should come before $45/quarter OTC benefits.
Well, paint my cat red and call it a fox. Thanks for the informative video. My employer coverage changed frequently as they chased lower premiums over the years. The best plan required almost no pre-authorizations. The next plan was cut rate, and almost everything required pre-approval. That's when I became very nervous about my cancer care. The biggest problem with the pre-authorizations were the people at the insurance company and the hospital system. There were mistakes and misunderstandings that put my care at risk and made me quite anxious, but, on paper, I had an excellent health plan. I and my wife recently chose original Medicare with medigap coverage partly as the result of our experiences with the poorly run plan discussed above. I am sure that some Medicare advantage plans are great while others really stink. I do not know any certain way of telling the difference until you use the plan. I am hoping that I (and my broker) made the right choice.
Thank you so much for watching! Your employer plan experience is actually an important thing to learn. The plan and company you (they - the employer in this instance) matters. Some plans/companies make life easy. Others don't. Much less to wade through on the supplement plan side though. Still need to pick solid companies, but less variability in the coverage rules for sure. 🦊
Wow, I think that I am in love with a Medicare-related fox 😂 There are no other brokers' YT videos that provide so much honest knowledge and insight based on factual data. You are awesome. I am relieved by the reality of Advantage denials. Now I will move on to more of your videos, knowing that I have a guardian angel informing my decision of what is best for me. I hope that your Massachusetts partner is even a fraction as good as you are.
I just received an email from United Healthcare on updates for 2025 and my prescription plan is staying the same. I was hoping to get the price for their Supplement G for New Hampshire but I couldn't find it. They just had updates for coverage. Do you know what they will be charging in 2025? Also, do we have to sign up for Medicare every year like the exchange plans? Or does the old one just carry over? Is Coyote close enough?
Coyote works :) 🦊 Supplement plans go on a different schedule, so they don't update rates during AEP. They vary by company and region, so could be January that they release updates... or April... or any month. I have a partner licensed in NH that would know more if you want to send me an email: erik@theretirementnerds.com You do not have to sign up for Medicare every year. As long as your Medicare plan is not going away and exiting the market, it will automatically renew and carry over to the next year.
THEY EAT THE FOXES! What is the threshold for deciding if a treatment or procedure requires pre-authorization? I am more concerned about this scenario: You go to a doctor for a medical issue. The doctor knows what it is and can treat it right away, but that treatment requires insurance approval, so the doctor has to request it and you have to return another day to get that treatment. Even if approval is granted without delay (and it's not a medical emergency), it still requires you to take time off and maybe find child care to come back a second time instead of dealing with the problem right there, once.
Most commonly, higher cost things, but there isn't really a set threshold amount, and each insurance company handles it differently. Some are more aggressive, others less so. 🦊
@@Theretirementnerds Thanks for the fast reply. The need to get approval is a bigger concern to me than the risk of rejection or time to get a decision. Sometimes we get a referral from a PCP to a specialist far away or who is hard to get, so when we get a chance to see them, we want to get it done then and there. Having to return is a big issue in some cases. That is more bothersome if the treatment is straightforward and there are not many options, but we need to get approval anyway.
@woofinu ya I'm all for supplement plans because of the much-reduced administrative burden. Speed of service, especially when dealing with Healthcare, is important
@@Theretirementnerds I don't know if the pre-approval requirement is a real issue or a "theoretical" one that can happen but almost never does, or happens only if there is a serious choice of treatments that merits further consultation and a 2nd/3rd opinion anyway.
As always, good, accurate information. At the present time I'm on high deductible g plan. I Chose that because of the arthritis that runs in my family. Fox in the hen house was something my grandmother always warned us about.
Thanks Eric. As always you’ve provided us with a good quality unbiased educational video regarding the various Medicare plans and benefits. I’m not sure how to slip in the word Fox but you’ll know why I said that. Anyway, keep up the good work.
Fox - Thanks for providing data/fact based view, it is important to see all sides. One aspect you didn't cover that I would like to see the data and understand is that I continually hear that it is costing the taxpayers more to cover an advantage plan patient than it costs to cover a traditional Medicare patient. Why is this? Even with the fraud, is traditional Medicare still a lower cost to the taxpayer than Advantage? Thanks, great videos.
Thank you so much! 🦊 Costs to Medicare are an interesting topic to dive into, and more complicated than a YT comment can give, but when dealing with costs and risk, there is realized risk and unrealized risk or liability. Think of it as fixed risk - you know how much and when it'll happen vs variable risk - you have no idea how much or how often it will happen. The second one is scarier for the person insuring against it, and it is the Original Medicare side. The first - fixed risk - is the Advantage side - again speaking FROM the government's perspective. It actually flips for the individual on Medicare. But for the government, it is less risky to pay a little more in fixed, known costs, to advantage plan companies to take on the unlimited variable risk that would sit with the government for those on Original Medicare. Behind the scenes, a lot of things are pushed through on the government side to encourage advantage plans, but never make YOUR healthcare decisions on what's best for the government. That's the super quick answer. Definitely NOT an endorsement for advantage plans, just the perspective of risk. Variable risk in this context has a number actuaries can assign to it that has a dollar value, but that's never counted in the things you see comparing government costs with Original Medicare vs Advantage. Hope that helps!
@@Theretirementnerds Thanks, I understand your explanation. This would be a topic I would love to see a deeper dive on. From the perspective of pushing the risks to the MA plans, I would expect that the MA plans would attempt to recoup those loses in future years by charging more, and if Medicare does not accept those higher charges, the MA plan would drop out of those markets pushing that liability onto other MA providers or back to original Medicare. A deeper dive that also explores why the MA plan promised savings to the taxpayer, but have not delivered any savings, just higher costs per member, would be an important and useful addition to your analysis here. Thanks again, great content.
I am still employed, no plans to retire, but am eligible for medicare next year (my enrollment period starts in December 2024). I have subscribed to your channel and have watched several of your videos, including the one that described options when you aren't going to retire and work for a company that has more than (I forgot how many you said) employees (my employer has thousands of employees.) I still have some questions that are specific to my own unique circumstances. You said you have brokers in all 50 states but you didn't really say how to contact you other than leaving a fox related comment. I am in Georgia, in the metro Atlanta area.
Thank you for watching! My email is erik@theretirementnerds.com if you'd like to reach out. If you already have, my apologies. I only see UA-cam usernames, not real names :)
Fox. I was on SCAN Advantage plan for 2 years and happy with it but got scared after watching some UA-cams that said how Advantage plans can deny treatments recommended by your doctors and how they make you leave skill nursing facilities prematurely after a surgery to save cost, so I switched to supplement plan G which costs a lot more. Now I am thinking if I should go back to SCAN. 🤔
@@Theretirementnerds I am most concerned about hospital stay and cancer treatment costs. Plan G has a limit on the number of days in the hospital but the SCAN Advantage plan doesn’t have a limit. So besides having to get approval from the insurance company, I can’t see a downside of the Advantage plan but everyone is telling me Plan G is the best and insurance companies are only interested in making a profit and there is no free lunch. Now I am torn. 😩
@Ccwuhccwuh it's important to remember that supplement plans are also insurance companies trying to profit 🙂 Use a Broker. Where you live makes a huge difference in the types of advantage plans and their track record, ease of use, etc. If you are happy with a supplement, keep it. They are amazing.
It's still managed Care. You want to pay as you go system choose HDG. Somebody will offer it in your state. It only takes one provider. Otherwise, choose plan N. Plan G will almost guarantee you a $400 a month plus premium by the time you're 85.
Totally get it 🦊 Definitely not trying to change people's minds who are on Supplement plans. LOVE supplement plans. The new number is 54% of medicare beneficiaries are on Advantage plans in 2024😲 This video is definitely more for them :) Appreciate you!!
Regardless of who has the "correct" denial statistics I don't need or want to think about it. I have been on Original Medicare and Plan G for 7 years and have never paid anything more than the annual deductible; never needed to worry about if a doctor was in my network (because there are none) and never have to worry about pre-approvals. I just go to whatever specialist I want and get the medical service or procedure I need. Done. If you like clever foxes then you choose right.
Fox:: I have a question: a lot of folks mention United. I am realizing now that there is United Healthcare and United American Health. Can I assume they are two separate companies? I turn 65 next year and right now am in a retiree medical plan. I found out there is also a retiree Medicare supplement plan (this year is United America Health-not sure if it will be the same for 2025. Is it better to get a discounted premium retiree medical supplement plan or still look elsewhere?
I have a stats background - it does not take many samples to see a pattern emerge. Past that rather small number, the song remains the same. Samples are an accepted, and statistically proven means of getting a picture. That said, that many samples across that many plans is probably not going to be valid.
FOX! NERDS! is my math right. It seems that your odds of being denied even after an appeal of something that should have been approved is 1 / 625. Figuring 0.16% from 0.96 improper denials X .17 not approved on appeals. So the basic equation is do you want to spend X amount of dollars more for a supplement plan vs advantage for a 1 / 625 chance of having a big problem IF you have a situation needing pre-authorization.
It gets a bit complicated because only about 10% of denials are appealed, so would probably need that to go up before we could confidently apply the appeal rate being stable enough to apply in that use case, but your general thoughts around being denied after an appeal are even lower. Appeals can take longer though. Important to remember that. Currently 14 days or less for a decision on an initial prior authorization (that will be reduced to 7 days). For an appeal, they have longer to try and sort through that, which can be an issue.
@@Theretirementnerds Masterfully nerdy analysis. Didn't realize that only 10% are appealed which seems remarkably low especially considering this involves medical care. And the time it takes is even worse. An almost 1/100 chance of getting denied for something you should have been approved of seems more problematic then. Still sticking with my plan though.
@happyron a lot of people don't know they can appeal. Should probably make a video on that. It is run through the provider office, so if you get denied, tell the office to appeal! Unless the provider already knows it's not medically necessary... again... 87% of denials likely would have been denied on Original Medicare, too, according to the 1st study.
Good Info as always, you're smart as a FOX (lol). I was wondering if you have any info on of the people that are denied, how many of them actually appeal? And wouldn't that be in the consumer for not appealing?
Thank you for sharing your experience! My goal here is not to convince people of one plan or another, but to hopefully help people like you already on one navigate the messages you'll hear about it in the news/UA-cam, etc... :)
Please do! Again... not advocating advantage plans, haha. For some reason, a lot of people misunderstand... but hopefully it helps explain certain things :) 🦊
As the shortage of healthcare workers continues, the ability to go any health care provider vs a network is a real benefit not to underestimate. Think like a fox.
BCBS of Kansas City is no longer offering Advantage plans in 2025. My AETNA PPO Advantage plan is also no longer going to be offered. Thanks to the "Inflation Reduction Act" (a.k.a. Medicare Advantage Plan Reduction Act).
Exactly. If you want a pay-as-you-go system, go with HDG and in the process keep all the benefits that go with original Medicare. Plan G is not a good value. So if you want comprehensive coverage and you can afford it go with plan N.
Thank you for watching. Not trying to change anyone's mind 🙂 love supplements. Trying to help those already on Advantage plans with this video in particular
Thank you for this video. I've had a MA PPO plan for years and so far very satisfied. At 82, I do not take medications and my doctor participats in tne plan. The plan provides Silver Sneakers which is important along with zero monthly cost. Code word fox.
As a licensed Medicare agent, I greatly appreciate your videos. There's no such thing as having too much knowledge. By the way, I thought it was really neat when a fox crossed the road in front of me.
Before I retired I used to fill in doing utilization review at my local hospital. They hated MA plans because they had to work harder to get treatments and days covered. After I retired I went on a MA plan because of the zero premiums and benefits offered. I am waiting for my MA plan to send out the ANOC so I can judge my options going forward and as long as my doctor and hospital system stay in network I see no reason to change. Thanks for this video, I watch them to the end and now trying to work a fox into my comment, lol!
As a health care professional, I urge everyone to be very careful going with advantage plans. Knowing the first hand how they work, I would NEVER suggest my parents to sign up. However, their sales folks are purchasing boats and luxury cars with their bonuses.
The fact of the matter is, some of us just can't afford a supplemental plan. Hell some of us can't afford part B but we pay for it anyway. You risk financial ruin if you try to rely on parts A&B alone. For most of us who have been using Employer Sponsored Health Insurance for decades, Advantage Plans are much the same. You get used to having your doctors /hospitals/medications changed because they leave your network. You just get used to it.
Good video and I am against Advantage plans, you are clearing the air about them. I always tell everyone, advantage plans are good -- IF you stay healthy. Be prepared to shell out a lot of money if you have any serious illness if you do have an advantage plan.
Over the 15 years or so that I have had an Advantage plan, I have been moderately unhealthy--multiple in-patient surgeries, etc. My premiums have had a very high return on investment: about $2000/year for premiums, and about $20,000-$40,000 roughly every other year in Advantage coverages.
I’m sorry but I don’t think the hassle of dealing with denials or having to start with a different treatment than your doctor prescribed and work your way up to the treatment your doctor actually wants just makes MA plans very unattractive. I had an HMO briefly, decades ago when I worked. My teenage son needed a pediatrician but the only in network doctor available in the very populated area where we lived was a gerontologist. My son ended up being denied a specific treatment he needed because the specialist thought the gerontologist should authorize it, and vice versa. I immediately switched back to a conventional BCBS plan and miraculously my son got the treatment he needed. If I wanted to deal with a bureaucracy I would have worked for the government. No thank you. Red tape doesn’t belong in healthcare to the extent MA plans use it as a tool to eventually deny care. I also find your repeated reference to the fact that this is an election year as an explanation for the negative headlines about MA plans undercuts your claims of objectivity regarding MA plans. Here’s your code word: Do you watch Fox a/k/a Faux News? Also, if supplement plans were free would you choose an MA plan for yourself?
Thank you for tuning in! This isn't meant to convince anyone to get an advantage plan. It's to help the 54% of Medicare beneficiaries on one know how they work. Supplement plans are great! Also, your HMO plan pre-65 that is covering a family is not an advantage plan. Switching to a conventional BCBS plan means you still switched to a managed care plan - sounds like it is more like a PPO. There are PPO advantage plans as well. Kind of sounds like you heard what you wanted to hear in the video. An election year is not the reason for the negative headlines. It is the reason for much more coverage around this topic than usual. These events happen every year - almost every month - in various parts of the country. If a supplement plan were free, everyone would get it, but their not, and millions cannot afford them or do not want them. For a supplement plan to become free, they would need to work like an advantage plan. Hope that helps!
@@Theretirementnerds I am aware my pre-65 coverage was not an advantage plan. I had never had a managed care plan in my entire working life (I was a NJ public school teacher for decades) until one year we were given a choice to try what the insurer itself called an HMO plan , and I decided to try it. It was managed care; maybe not exactly what an MA plan is today but it was the insurance company making my family’s health care decisions, which is the bottom line for advantage plans today. The BCBS plan was NOT a PPO. It was what used to be conventional insurance with the doctor and the patient having the final word, not the insurance company. As far as hearing what I wanted to hear- I merely repeated what you said at least twice in the video, and your saying it implied to me that you were intimating one party or the other was trying to make political bank out of it. I believe that you were trying to show a balanced view of MA plans, and gave context as to the scope of the hospital systems opting out. But here’s the thing- if systems opt out then patients often have to find new doctors as well as new medical facilities. I see 4 specialists and I cannot imagine having to change FIVE doctors. I read that a whole system somewhere in the Cascades opted out, which meant people had to travel many miles to another facility for healthcare. That’s not something elderly people should have to do. I don’t recall reading that hospital systems are opting out of original Medicare, so that’s another downside to MA plans, plus these plans are only for one year and their terms can change every year, which can be good or bad. Another downside is that once you have an MA plan, unless you can pass underwriting to get a supplement, you are stuck with an MA plan or just original Medicare, except in a few states. You’re stuck with the MA plan’s drug formulary as well. Lastly, MA insurers are incentivized by the federal government to deny care since they keep more government money when they do. I like your channel and I think you do a great job. I just felt the need to chime in. Thank you for responding to my comment.
@@mey7579 please know I welcome and appreciate all of these viewpoints. I agree with you on most of them as well. Given your health history and desire for network freedom, neither us nor anyone who would consult with you about Medicare should push you towards an advantage plan. I think that's the biggest problem we have with things like Medicare call centers (private companies) that throw out commercials saying Advantage plans are better than OM and the call centers are pushing everyone, whether it's a fit or not, into advantage plans. Not explaining what we've explained in this video and others, nor what you've explained in your comment (we have videos that address these points in more detail). I have a video I'm currently editing around the networks and systems dropping advantage plans. That isn't quite as dire as most are pitching it. It is a problem, though. That video also cites an election year as to why it is so publicized. Both sides use things like this to try and sway the senior voter base. Hoping to post that one this weekend. Politically, I can't stand either party on this issue, which is why I don't want to be connected, even loosely, with either :) Both make promises that never happen. Both have been "in power" to make changes and haven't. Both have made changes to the program that have ripple effects that end up hurting the Medicare beneficiary. I think a lot of the entities involved worry less about the beneficiaries and more about the insurance companies, drug manufacturers, PBMs, hospitals...
The info provided is nice. But I can tell this person has never worked with provider reimbusement plans. I hve seen them pay as low as 1.50 to a provider for services
He's not trying to convince anyone of anything, he's explaining MA plans to people who have them or are considering them. He personally prefers Advantage plans, as he has made clear. Obviously you were not paying attention.
@douglasjensen8986 clarification... i personally prefer whatever plan is best for the individual 😊 If everyone could afford a supplement plan, I'd want everyone on it. For those who can't or don't want one, an advantage plan is a good option. My mom had a supplement. My dad has Advantage. They both picked them, knowing full well what each entails.
More than 500,000 Americans are scheduled to lose their Medicare Advantage plans now that major insurer Humana is leaving 13 markets across the country. It seems the might have been something worth mentioning
@@Theretirementnerds Thanks. I enjoy you videos. Some quick research showed the commission a broker makes for a MA plan would be approx $611 on the initial sale and 1/2 upon renewal. So, $ 916 in 2 years. My Plan G commission yielded my agent approx $223 for the 1st year and $186 for year 2. Approx total of $409. I do think you are honest and forthright, but that is a huge incentive for a less ethical representative to push MA. As you state, no one plan is right for all. My best friend is on a MA plan and is very happy. Thanks for your work. p.s. What does the fox say?
@tomt.9843 haha! don't let my kids see that... 🦊 Yes, I 100% agree there is an incentive there. Before 2025, one thing to remember on the supplement plan side is many people will also get dental, vision, and a drug plan with the supplement plan side that also have commissions tied to them. While small, they do close the gap a little. In 2025, many Part D plans are doing away with commissions. A couple other conflicts to know (I've thought about doing a video on this): 1. Advantage companies have the higher commission. Supplement plan companies, dental, and other ancillary plans can offer incentive trips. Put enough business with them, and get an all-expense paid, 10-day trip to Bali with your spouse(as an example). The service burden on those who only do supplement plans with no drug help is remarkably lower than advantage or those who do help with Part D. There are many who will just do supplement plans with one insurance company (that does incentive trips) tells the client to figure out Part D and hopes they never hear from the client again. So... there are incentives to both directions. Our philosophy - Do what's best for the individual. If a supplement is the best fit, help them with that supplement. While the commission is less, if they are happy and refer their spouse, neighbor, friends... that's better than forcing someone on an advantage plan for that higher commission, they are unhappy, and don't refer their friends/family. Each happy client ends up bringing 5-10 referrals, and that's how solid agencies end up growing ethically I think. That was long... sorry about that.
They can enroll in another Advantage plan, or use their Guaranteed Issue Rights to enroll in original Medicare with a Supplement, which they are eligible to do since their Advantage plan is being discontinued.
I so respect your videos and your balanced approach to discussing the traditional Medicare w/ a supplement plan vs Medicare Advantage plans. I have referred others to your videos when they have to make the choice between the two. I'm fortunate enough to be able to afford a supplement plan. I love knowing the absolute certainty of what is covered and not worrying every year about the annual changes that can and do occur with an Advantage plan. IN MY OPINION, a person doesn't have to be as clever as a fox to know, if you desire "peace of mind" now and in the future, surrounding not being denied admission into a hospital of my choice and finding out in the future that speciality places like the Mayo Clinic will not accept Advantage plans, getting a supplement plan would be the way to go. Thank you . :-)
I agree with you. For people who can afford a supplement plan and value the freedom that route offers, it is the way to go. Appreciate you spending time with me and sharing these with your friends
I’m on a supplement plan because I live in 2 states and want no network limitations. (I haven’t figured out how to weave fox into my comment). While I am biased towards supplement plans I am quite impressed on the excellent care my brother in law is getting for brain cancer treatment in Florida from his Advantage plan. Your analysis was very helpful.
Thank you so much for sharing your thoughts and logic 🦊
Ya, I hope it doesn't come off as me trying to convince people to switch. Much more about those already on an advantage plan understand how it works and navigate the messages they may be hearing out there. Appreciate you!
Thank you very much! I've been on an Advantage Plan since I went on Medicare, and I love it! Never been denied any services, all my drugs are covered, I see the doctors I want to see. When I had back surgery back in 2017, my out-of-pocket was around $1K. I've never come any near the deductible. I live in VT and there is a minimal premium, but for what i get, absolutely no complaints! FOX!
Thank you so much for watching and sharing your experience!
Vermont is beautiful! Did you see the Vermont video we did? :)
ua-cam.com/video/Ny6LfpPn0xE/v-deo.html
When you showed the page with the health care companies/systems not accepting certain companies/only accepting certain companies/not accepting any companies, it made me realize how bad MA plans are. We have had Humana MA for several years, but the very, very large medical system in our area may not accept Humana MA plans starting in April 2025. If this happens, and it may (especially seeing that page), we then become very limited in our medical options without going out-of-network. Since this has not been resolved, we could not possibly stay with Humana. Actually, we view this as an opportunity to get on a Medicare supplement plan and get away from MA plans.
Eric - thank you sooo much for the invaluable service you provide to those of us newer to Medicare. I’m glad you are doing this full time because so few people provide this information and balanced presentation, with a focus on real data. You are a fox. It this age of social media, I’m sure you have get some, maybe a lot of negative feedback, but you are doing a great job. I’ve watched many of your videos and have learned a great deal. These are critical decisions for retirees and having unbiased, well informed information and guidance is rare. Keep up the great work! Much appreciated.
Appreciate you saying this 🦊
There is a lot of negativity that gets tough to balance sometimes, but comments like yours make it all worth it. Being able to do UA-cam full time also helps eliminate any appearance of bias or conflict. There wasn't any before, but now there shouldn't even be any inkling of possibility there. Thank you!!
Hi Eric, thanks for these videos of interest. I guess it's safe to say that Advantage plans are great depending on where you live. I for one, am in Fort Worth Texas, and my Advantage plan has an unbelievable number of Primary care and Specialist Doctors, and at least 8 hospitals within a 10 mile radius. I have also done some research, I have called a few clinics and hospitals in network to make sure my plan is still accepted. And what I like most about my plan, is the preventative care. My Doctor performs labs and test to ensure my health is as it should be. Overall, I am very pleased with my Advantage plan.
Thank you so much for sharing this my friend! Always appreciate your comments.
Yes... where someone lives is (in my opinion) the single most important determining factor in this decision.
Just wait
I am so thankful for your videos as I feel they provide me with factual information, pointing me in the right direction for research in making good solid choices for our life. You are like a fox in your presentation and work.
I have recently heard about some advantage plans leaving the network, so I will be checking out your next video on this subject and may be in search for an agent to assist. Thank you for your work.
Thank you so much for watching! 🦊
Here is the network video:
ua-cam.com/video/lS1LJS9tues/v-deo.htmlsi=YqEgspGs0n8Ra97v
Thank you for putting Medicare Advantage in "perspective." But when I choose next year, I think I will choose between suppliment plans G, or N.
Supplement are amazing!
Here is my fox. A necessary statistic for denial is how much claim money was denied for the patients where it shouldn't have been denied. The reason is that they can still look good statistically on claims but maybe not on the amount of money of claims denied. Obviously, the amount is more catastrophic for a patient.
A business can look at the statistics being used and then do things to make those not look too bad but when you dig deeper there might be a problem.
Please note, I am not saying there is a problem. I just feel that the statistics used might not show the full picture either way.
🙂
Completely agree! One thing that is so hard with this industry is the availability of reliable data... and then... more granular breakdowns of that. Like the 1st study, I think the conclusions aren't really statistically solid. The 2nd study just looks at everything and doesn't try to draw conclusions as much as just point out the numbers. Hard to know the full picture with millions and millions of claims and experiences :)
Appreciate you!
Thank you, Erik. You are doing a great job educating us! I am learning so much from you. Don't let the agitators get to you, just ignore them and sneak past them like a Fox.
Thank you so much! 🦊
They are out there. Trying my best :)
@@Theretirementnerds I can imagine how discouraging and hurtful it would be to be attacked so ruthlessly when you are in the public eye in the way that you are. People feel free to be so vocal and make accusations without any evidence. It seems to be the time we are living in. I will continue to enjoy and appreciate everything you do to educate us about all thing’s retirement. Thank you for all you do!
Fox in the hen house. Haven't heard that since I was a Yonker. As for Advantage plans I do not see how they differ from my employer health plan. I have to use the network and even then can be denied payment. I pay copay, deductibles, and have a MOOP. The insurance decides what medications I can get and requires a mail service pharmacy. Not really sure I would notice a difference personally.
Very similar to employer plans. Both are typically managed care plans. Advantage plans just usually don't have a deductible.
My PCP just left the network to go to a concierge service. There are no new patient openings with the remaining doctors. Being on Medicare instead of Advantage, I can find a new doctor outside of that network, although it is a hassle since ancillary services are in that network. Advantage plan members will have to switch networks or travel some distance to find a doctor.
My PCP did the same (he waited until his kids graduated from college), I don't blame him. My Advantage plan guarantees I will have a PCP, so when I couldn't find one, one of the (two) huge hospital chains in my Advantage plan's network found me four to choose from. Two are within 10 miles of my home, two are at the hospital I go to.
Red fox, Grey fox how do you discern the difference? So easy to be fooled. As always your information clears up the difference! Keep up the great work for all us retired nerds
Thank you so much for tuning in! 🦊
Appreciate you!
We have a Fox that plays in the field by our house. I love the way you explain things down to the finest detail with the time allowed in your videos. I was told recently that BCBS is pulling out of the Kansas City market for advantage plans. I was also told that Aetna (my current provider) has lost it's ability to contract with North Kansas City Hospital. While that doesn't have an affect on my health provider it does raise a question. If I'm entered into a contract with an insurance company for 1 year, yet their contract with a hospital falls through, why shouldn't the insurance company be required to fulfill my needs to the end of my annual term? I'm not provided the ability to change insurance companies in the middle of the year, so why are insurance companies allowed to make such a drastic change in the middle of the year?
I agree with you on this one. I recorded a video today about advantage plans leaving markets. Hoping to edit that and get it out soon. With the plan leaving the market, people actually have more flexibility and freedom than if my plan just changed negatively.
I like the idea of being able to switch plans if a provider contract ends. Won't ever happen, but I like the concept of it.
@@Theretirementnerds I just watched the newest video you mentioned and it looks like I'm going to have an interesting visit with my broker. Thanks for what you do.
You are the epitome of integrity. No fox snooze here.
Appreciate you so much! Thank you for spending time with me and your support! Means more than you know!
Fox. Hearing about a 92 year old who fell during a blizzard and needed immediate surgery have to go through pre authorization up to three days is enough of a turnoff. The other one I hear about is chemotherapy co-pays. I can afford plan g and avoid potential trouble.
That time between receiving the prior authorization and approving is something I have issue with as well.
Here is a video on cancer treatment on both:
ua-cam.com/video/77YF-TL0n-8/v-deo.html
🦊
Thank you Eric for another wonderful and very honest video. You are as sly as a fox, never giving your opinion as to which plan a person should buy. This video was the comfort that I really needed in helping me in deciding to go with a Medicare Advantage plan for 2025. This summer, when you passed through my state of Nevada, you mentioned that we have some of the best plans in the entire country and anyone who lives in Las Vegas should actually take an honest look at them. For the last few months, I have been doing my homework and decided to drop my supplement plan, which has been costing me a fortune, and I have never used. For 35 years I have had a plan similar to Medicare Advantage in the workplace and it worked absolutely fine for me. Although only God knows the future for our health, I think everyone is different and each one should make a decision as to what is right for them. I have friends a lot older than me who have always been on Medicare Advantage and have never had any problem with it. I will definitely try it for one year and utilize my “trial right #2,” knowing that if it doesn’t work out, I can go back to my supplement plan. Thank you for all of the wonderful knowledge that you have given us!
Appreciate you and your support! Definitely not trying to persuade anyone one way or the other here 🙂
Just trying to show how they work.
Really wish we could've connected when we passed through. I blame myself! 🦊
I have been doing the same as you, researching like crazy to determine if an Advantage plan is a better option for my husband and I. Although we can afford our supplement plan N premiums, drug costs, dental and vision out of pocket, I see the value in having an Advantage plan with these benefits included at no extra cost. It was my 2025 part D drug ANOC that prompted the research on Advantage plans. But then I watched several YT videos with the scare tactics that Eric mentioned, that I will surely die at the hands of the evil insurance companies, and then I think I should just remain with my current Plan N. This video has put me at ease that I’m not crazy to consider a switch for at least a year. We live in a large urban area in Texas and from what I have found the networks are very large. Eric pointed out that where you live is a major determinant in your decision and I find this to be true. I also will be able to exercise my 2nd trial right to be able to switch back to my Plan N if I find that Advantage isn’t for me. Wonderful and informative video, Eric!
Thanks, ERIC for the “foxy” well crafted comments back by accredited documentation breath of fresh air as we try to navigate our way through an overly complicated system being thrust on our seniors.
Thank you so much for watching! 🦊
Fox. Thanks for a rational discussion regarding MA plans. There's not too much of that these days.
Thank you for watching! 🦊
For some reason, rational conversations are harder to come by these days.
Thanks for all the help Eric "Fox" brother of knowledge! Keep the train a roll'n, we need you to present clear and concise data.
Thank you so much for tuning in! 🦊
I value the education you provide. I thought to myself I would like to do business with this firm, however, I am confused as I heard you say at the end your video, your revenue stream is through educating others through UA-cam. You referenced Brokers as peers, which you value their knowledge, and they have your trust, but who do they work for? Do you provide oversight over them or just have a good relationship to "feel" they will do the right thing for the customer. Could you provide more clarity of the working model?
I am not sure how I will get notified when or if you post a video that explains your model, but I am really interested. I suppose I am one of those old foxes who couldn't chase a chicken if I wanted to, but if there is anyone I do business with that would be you. Thanks again for everything you do. You are AWESOME!!!!
Appreciate you watching and your kind words! Happy to explain in more detail. Email is probably better than the UA-cam comment section :) My email is erik@theretirementnerds.com if you'd like to connect.
I’m sticking to my Original Medicare plan g supplement for now, but I’ll continue to keep an eye on the how MA part C plans in my area respond to all these changes. Recently I did get a friend having trouble with a MA plan to work with an agent to use my state’s birthday rules to change to a better insurance company. Recently we have had a resurgence of native species foxes 🦊 over the invasive kind in the regional parks near me.
Thank you so much for watching! Definitely not trying to persuade anyone away from the supplement plans :) Love, LOVE supplement plans. More just trying to help those already on an advantage plan deal with what they are seeing/hearing. Appreciate you! Love seeing your comments and your support! 🦊
Another great, informative, data driven video. Thanks. My wife and I have been on various Advantage Plans for 8 years. Over those years we have had several surgeries and hospital stays with no problems related to prior authorizations and networks. The Advantage Plans have worked well for us. In 2025 we are both planning on moving to Medicare + Supplement (HDG) since we will be splitting our time between Utah and New York (our current state of residence). I plan on calling your office to get the contact info for your NY State partner so that I can discuss the best path forward. Thanks again.
Thank you so much for sharing your experience! My email is erik@theretirementnerds.com
Probably the best way to reach me 🙂
Thankfully you didn't push the Fox channel!! Loved your video. I have a supplement (G). My wife has AARP (UHC) Advantage. Unfortunately, they've been going through dealing with the local hospital systems (Duke and UNC) and have had issues. So far, negotiations have worked but you never can be sure. I have too many health issues to take the chance so I am keeping my supplement even though my agent thinks I should switch. So, my question is, do the agents make more off the advantage plans or the supplements? It sure seems to me that it should be the supplement. Just curious.
Thank you for watching! 🦊
Yes, agents will typically make more in 1st year commissions on advantage plans than supplement plans. We have a lot of videos about this and where we stand on that topic, but yes, advantage plan commissions are regulated by the federal government and are higher. Supplement plan commissions are not regulated by the federal government are typically not the same as advantage plan commissions.
Thanks Erik! We have foxes around here, but we also are careful with the weasels. We need to keep the chicks safe. Your information and keeping us updated with the facts is appreciated.
Thank you so much for taking the time to watch! 🦊
Thank you FOX!
Appreciate you watching! 🦊
We get a red fox going through our yard.
I have only been on Medicare for 3 months, I have a supplement, going back and forth what to do next year
It breaks my heart certain agents will put people in these plans without a full breakdown of what could go wrong. All health insurance has risks; but many sell these only talking about freebie perks. Thank you for spreading the word and educating people
Agreed! Our take: Inform the person about pros and cons of both as close to the reality as possible without fear-mongering or the perks... ugh... the perks. Hospital and Medical coverage and access should come before $45/quarter OTC benefits.
@@Theretirementnerds we take the same approach. But It’s crazy how much people want to focus on otc cards and gym memberships hahaha.
@@njlifeandhealth and then never use either. The numbers are wild around how few people use those benefits
Thank you for your insights !
Appreciate you taking the time to watch!
Well, paint my cat red and call it a fox. Thanks for the informative video.
My employer coverage changed frequently as they chased lower premiums over the years. The best plan required almost no pre-authorizations. The next plan was cut rate, and almost everything required pre-approval. That's when I became very nervous about my cancer care.
The biggest problem with the pre-authorizations were the people at the insurance company and the hospital system. There were mistakes and misunderstandings that put my care at risk and made me quite anxious, but, on paper, I had an excellent health plan.
I and my wife recently chose original Medicare with medigap coverage partly as the result of our experiences with the poorly run plan discussed above. I am sure that some Medicare advantage plans are great while others really stink. I do not know any certain way of telling the difference until you use the plan. I am hoping that I (and my broker) made the right choice.
Thank you so much for watching! Your employer plan experience is actually an important thing to learn. The plan and company you (they - the employer in this instance) matters. Some plans/companies make life easy. Others don't.
Much less to wade through on the supplement plan side though. Still need to pick solid companies, but less variability in the coverage rules for sure. 🦊
Wow, I think that I am in love with a Medicare-related fox 😂 There are no other brokers' YT videos that provide so much honest knowledge and insight based on factual data. You are awesome. I am relieved by the reality of Advantage denials. Now I will move on to more of your videos, knowing that I have a guardian angel informing my decision of what is best for me. I hope that your Massachusetts partner is even a fraction as good as you are.
I just received an email from United Healthcare on updates for 2025 and my prescription plan is staying the same. I was hoping to get the price for their Supplement G for New Hampshire but I couldn't find it. They just had updates for coverage. Do you know what they will be charging in 2025? Also, do we have to sign up for Medicare every year like the exchange plans? Or does the old one just carry over? Is Coyote close enough?
Coyote works :) 🦊
Supplement plans go on a different schedule, so they don't update rates during AEP. They vary by company and region, so could be January that they release updates... or April... or any month. I have a partner licensed in NH that would know more if you want to send me an email: erik@theretirementnerds.com
You do not have to sign up for Medicare every year. As long as your Medicare plan is not going away and exiting the market, it will automatically renew and carry over to the next year.
i see so many bad things about advantage plans been on one for 2 yrs and its been not to bad had an issue and it was handle pretty well fox
Thank you for sharing your experience! 🦊
Another great video. Thanks Eric. I am still a long way to Medicare but it’s fun to do the research. You are one of my trusted resources!! Foxy 🦊
Appreciate you watching and your support! 🦊
THEY EAT THE FOXES! What is the threshold for deciding if a treatment or procedure requires pre-authorization? I am more concerned about this scenario: You go to a doctor for a medical issue. The doctor knows what it is and can treat it right away, but that treatment requires insurance approval, so the doctor has to request it and you have to return another day to get that treatment.
Even if approval is granted without delay (and it's not a medical emergency), it still requires you to take time off and maybe find child care to come back a second time instead of dealing with the problem right there, once.
Most commonly, higher cost things, but there isn't really a set threshold amount, and each insurance company handles it differently. Some are more aggressive, others less so. 🦊
@@Theretirementnerds Thanks for the fast reply. The need to get approval is a bigger concern to me than the risk of rejection or time to get a decision.
Sometimes we get a referral from a PCP to a specialist far away or who is hard to get, so when we get a chance to see them, we want to get it done then and there. Having to return is a big issue in some cases. That is more bothersome if the treatment is straightforward and there are not many options, but we need to get approval anyway.
@woofinu ya I'm all for supplement plans because of the much-reduced administrative burden. Speed of service, especially when dealing with Healthcare, is important
@@Theretirementnerds I don't know if the pre-approval requirement is a real issue or a "theoretical" one that can happen but almost never does, or happens only if there is a serious choice of treatments that merits further consultation and a 2nd/3rd opinion anyway.
As always, good, accurate information. At the present time I'm on high deductible g plan. I Chose that because of the arthritis that runs in my family. Fox in the hen house was something my grandmother always warned us about.
Thank you so much for watching! 🦊
High Deductible G is quite popular in certain pockets of the country :)
Thank you for the information on Medicare Advantage plans. You do an awesome job! Enjoy your evening watching the foxes in your backyard.
Thank you so much for watching! 🦊
Thanks Eric. As always you’ve provided us with a good quality unbiased educational video regarding the various Medicare plans and benefits. I’m not sure how to slip in the word Fox but you’ll know why I said that. Anyway, keep up the good work.
Haha! You did a great job 🦊
Thank you so much for tuning in and your support!
Fox - Thanks for providing data/fact based view, it is important to see all sides. One aspect you didn't cover that I would like to see the data and understand is that I continually hear that it is costing the taxpayers more to cover an advantage plan patient than it costs to cover a traditional Medicare patient. Why is this? Even with the fraud, is traditional Medicare still a lower cost to the taxpayer than Advantage? Thanks, great videos.
Thank you so much! 🦊
Costs to Medicare are an interesting topic to dive into, and more complicated than a YT comment can give, but when dealing with costs and risk, there is realized risk and unrealized risk or liability. Think of it as fixed risk - you know how much and when it'll happen vs variable risk - you have no idea how much or how often it will happen.
The second one is scarier for the person insuring against it, and it is the Original Medicare side. The first - fixed risk - is the Advantage side - again speaking FROM the government's perspective. It actually flips for the individual on Medicare.
But for the government, it is less risky to pay a little more in fixed, known costs, to advantage plan companies to take on the unlimited variable risk that would sit with the government for those on Original Medicare. Behind the scenes, a lot of things are pushed through on the government side to encourage advantage plans, but never make YOUR healthcare decisions on what's best for the government.
That's the super quick answer. Definitely NOT an endorsement for advantage plans, just the perspective of risk. Variable risk in this context has a number actuaries can assign to it that has a dollar value, but that's never counted in the things you see comparing government costs with Original Medicare vs Advantage. Hope that helps!
@@Theretirementnerds Thanks, I understand your explanation. This would be a topic I would love to see a deeper dive on. From the perspective of pushing the risks to the MA plans, I would expect that the MA plans would attempt to recoup those loses in future years by charging more, and if Medicare does not accept those higher charges, the MA plan would drop out of those markets pushing that liability onto other MA providers or back to original Medicare. A deeper dive that also explores why the MA plan promised savings to the taxpayer, but have not delivered any savings, just higher costs per member, would be an important and useful addition to your analysis here. Thanks again, great content.
I am still employed, no plans to retire, but am eligible for medicare next year (my enrollment period starts in December 2024). I have subscribed to your channel and have watched several of your videos, including the one that described options when you aren't going to retire and work for a company that has more than (I forgot how many you said) employees (my employer has thousands of employees.) I still have some questions that are specific to my own unique circumstances. You said you have brokers in all 50 states but you didn't really say how to contact you other than leaving a fox related comment. I am in Georgia, in the metro Atlanta area.
Thank you for watching! My email is erik@theretirementnerds.com if you'd like to reach out.
If you already have, my apologies. I only see UA-cam usernames, not real names :)
Fox. Thank you for your educational videos! How does one become one of your trusted Medicare referral partners? Im in northern Illinois.
Thank you for watching! My email is erik@theretirementnerds.com if you'd like to reach out 🙂
Thank you for your excellent vid, The Retirement Nerds, it was electrifying!😸
Appreciate you taking the time to listen to me ramble 🫠
@@Theretirementnerds " Lord, I was born a ramblin' man."😀
Fox. I was on SCAN Advantage plan for 2 years and happy with it but got scared after watching some UA-cams that said how Advantage plans can deny treatments recommended by your doctors and how they make you leave skill nursing facilities prematurely after a surgery to save cost, so I switched to supplement plan G which costs a lot more. Now I am thinking if I should go back to SCAN. 🤔
Thank you for watching! 🦊
There's a lot of fear mongering out there. Some is warranted. Most is not.
@@Theretirementnerds I am most concerned about hospital stay and cancer treatment costs. Plan G has a limit on the number of days in the hospital but the SCAN Advantage plan doesn’t have a limit. So besides having to get approval from the insurance company, I can’t see a downside of the Advantage plan but everyone is telling me Plan G is the best and insurance companies are only interested in making a profit and there is no free lunch. Now I am torn. 😩
@Ccwuhccwuh it's important to remember that supplement plans are also insurance companies trying to profit 🙂
Use a Broker. Where you live makes a huge difference in the types of advantage plans and their track record, ease of use, etc. If you are happy with a supplement, keep it. They are amazing.
@@TheretirementnerdsBut they are very expensive compared to Advantage plans. Could you refer me to an insurance broker in California?
@Ccwuhccwuh send me an email to erik@theretirementnerds.com and I can give you a couple options.
Good solid advice. Thank you. We had a fox in our backyard-and a bobcat too-really!
Woah! That's pretty nuts! 🦊
It's still managed Care. You want to pay as you go system choose HDG. Somebody will offer it in your state. It only takes one provider. Otherwise, choose plan N. Plan G will almost guarantee you a $400 a month plus premium by the time you're 85.
Agree with you. Love supplement plans. Hopefully this helps those who have already made their decision. Appreciate you watching!
The KFF (kaiser, foxtrot, foxtrot 😉) study is very interesting, as is the whole video. Thanks Erik!
Love it :)
It is a super useful thing to look at with full data rather than samples 🦊
I have a fox that I see in my yard sometimes, for me it's about networks, I like to travel a little and I was always worried when I was out of my area
Totally get it 🦊
Definitely not trying to change people's minds who are on Supplement plans. LOVE supplement plans. The new number is 54% of medicare beneficiaries are on Advantage plans in 2024😲 This video is definitely more for them :) Appreciate you!!
Regardless of who has the "correct" denial statistics I don't need or want to think about it. I have been on Original Medicare and Plan G for 7 years and have never paid anything more than the annual deductible; never needed to worry about if a doctor was in my network (because there are none) and never have to worry about pre-approvals. I just go to whatever specialist I want and get the medical service or procedure I need. Done. If you like clever foxes then you choose right.
Fox:: I have a
question: a lot of folks mention United. I am realizing now that there is United Healthcare and United American Health. Can I assume they are two separate companies? I turn 65 next year and right now am in a retiree medical plan. I found out there is also a retiree Medicare supplement plan (this year is United America Health-not sure if it will be the same for 2025. Is it better to get a discounted premium retiree medical supplement plan or still look elsewhere?
I have a stats background - it does not take many samples to see a pattern emerge. Past that rather small number, the song remains the same. Samples are an accepted, and statistically proven means of getting a picture. That said, that many samples across that many plans is probably not going to be valid.
Thank you so much for tuning in!
FOX! NERDS! is my math right. It seems that your odds of being denied even after an appeal of something that should have been approved is 1 / 625. Figuring 0.16% from 0.96 improper denials X .17 not approved on appeals. So the basic equation is do you want to spend X amount of dollars more for a supplement plan vs advantage for a 1 / 625 chance of having a big problem IF you have a situation needing pre-authorization.
It gets a bit complicated because only about 10% of denials are appealed, so would probably need that to go up before we could confidently apply the appeal rate being stable enough to apply in that use case, but your general thoughts around being denied after an appeal are even lower.
Appeals can take longer though. Important to remember that. Currently 14 days or less for a decision on an initial prior authorization (that will be reduced to 7 days). For an appeal, they have longer to try and sort through that, which can be an issue.
@@Theretirementnerds Masterfully nerdy analysis. Didn't realize that only 10% are appealed which seems remarkably low especially considering this involves medical care. And the time it takes is even worse. An almost 1/100 chance of getting denied for something you should have been approved of seems more problematic then. Still sticking with my plan though.
@happyron a lot of people don't know they can appeal. Should probably make a video on that. It is run through the provider office, so if you get denied, tell the office to appeal!
Unless the provider already knows it's not medically necessary... again... 87% of denials likely would have been denied on Original Medicare, too, according to the 1st study.
@@Theretirementnerdsincorrect. Traditional mcare does NOT REQUIRE PA
@@joannejohnson85 not following. I don't say Traditional Medicare requires a PA in his comment chain. We're talking about Advantage plans...?
Is that a live plant behind you? Thanks for this video!
It is a very realistic fake plant :)
Good Info as always, you're smart as a FOX (lol). I was wondering if you have any info on of the people that are denied, how many of them actually appeal? And wouldn't that be in the consumer for not appealing?
The individual and the provider. The provider can submit the appeal. That Kaiser article has the number of appeals. Only about 10% are appealed.
Thank you for your video. Info is power and the correct info so important to be able to make the right decisions for each person. Fox
Appreciate you taking the time to watch! 🦊
I’m on an MA plan and have really liked it. Looking at my options and your video is a breath of fresh air. Thank you so much!!!
Thank you for sharing your experience! My goal here is not to convince people of one plan or another, but to hopefully help people like you already on one navigate the messages you'll hear about it in the news/UA-cam, etc... :)
@BGood496 I agree. I am happy with my MA. I've had it 3 years. I will look at the plans for 2025. But happy so far!
I'll be sending this out in my annual email to my clients. (I cant come up with a fox comment off the top of my head though).
Please do!
Again... not advocating advantage plans, haha. For some reason, a lot of people misunderstand... but hopefully it helps explain certain things :) 🦊
As the shortage of healthcare workers continues, the ability to go any health care provider vs a network is a real benefit not to underestimate. Think like a fox.
Great point! 🦊
BCBS of Kansas City is no longer offering Advantage plans in 2025. My AETNA PPO Advantage plan is also no longer going to be offered. Thanks to the "Inflation Reduction Act" (a.k.a. Medicare Advantage Plan Reduction Act).
Releasing a video on this topic this weekend! Stay tuned!
This hasn't changed my mind one bit.
Exactly. If you want a pay-as-you-go system, go with HDG and in the process keep all the benefits that go with original Medicare. Plan G is not a good value. So if you want comprehensive coverage and you can afford it go with plan N.
Thank you for watching. Not trying to change anyone's mind 🙂 love supplements. Trying to help those already on Advantage plans with this video in particular
@@Theretirementnerds
👍
Thank you for this video. I've had a MA PPO plan for years and so far very satisfied. At 82, I do not take medications and my doctor participats in tne plan. The plan provides Silver Sneakers which is important along with zero monthly cost. Code word fox.
Thank you so much for watching and sharing your experience! 🦊
Great video as usual. you Fox.
Haha, thank you for watching! 🦊
As a licensed Medicare agent, I greatly appreciate your videos. There's no such thing as having too much knowledge. By the way, I thought it was really neat when a fox crossed the road in front of me.
Thank you so much for tuning in! :) 🦊
In my state, two large providers have announced they will no longer accept United Health Care Advantage Plans effective 1/1/2025. That is a fact.
But it is not a fact that is generally meaningful.
@@douglasjensen8986 ??????????????????
Before I retired I used to fill in doing utilization review at my local hospital. They hated MA plans because they had to work harder to get treatments and days covered. After I retired I went on a MA plan because of the zero premiums and benefits offered. I am waiting for my MA plan to send out the ANOC so I can judge my options going forward and as long as my doctor and hospital system stay in network I see no reason to change. Thanks for this video, I watch them to the end and now trying to work a fox into my comment, lol!
Thank you so much for watching to the end 🦊
Yes... keep an eye out for the ANOC! So important to review that!
We're all advantage Foxes now.
Haha! Hopefully it helped clear some things up 🦊
Fox News😊I am on plan N. I have friends on advantage plans. They are mostly happy with the plans. To each his own
Thank you for watching! Can't endorse or reprimand any news station, but appreciate you making it to the end :) 🦊
As a health care professional, I urge everyone to be very careful going with advantage plans. Knowing the first hand how they work, I would NEVER suggest my parents to sign up. However, their sales folks are purchasing boats and luxury cars with their bonuses.
The fact of the matter is, some of us just can't afford a supplemental plan. Hell some of us can't afford part B but we pay for it anyway. You risk financial ruin if you try to rely on parts A&B alone. For most of us who have been using Employer Sponsored Health Insurance for decades, Advantage Plans are much the same. You get used to having your doctors /hospitals/medications changed because they leave your network. You just get used to it.
What the fox say? Look, who needs data when you have sincerely held beliefs? COVID taught me that.
🦊 haha... so true.
🦊
There he is... :) 🦊
Thanks for your integrity. I’m going fox hunting for a good plan. :)
Haha thank you so much Linda! Appreciate you and your support! 🦊
This was another very helpful video. You are sly like a fox.
Thank you so much for watching! 🦊
Fox
Thank you so much! 🦊
Insurance companies have a responsibility to their stockholders, nothing more.
fox
Thank you so much! 🦊
Fox
Thank you so much! 🦊
I trust you and you are helping me understand my choices. If I was a chick, I would say you are a Fox.
Thank you for watching! Glad it is helpful! 🦊
Good video and I am against Advantage plans, you are clearing the air about them. I always tell everyone, advantage plans are good -- IF you stay healthy. Be prepared to shell out a lot of money if you have any serious illness if you do have an advantage plan.
Over the 15 years or so that I have had an Advantage plan, I have been moderately unhealthy--multiple in-patient surgeries, etc. My premiums have had a very high return on investment: about $2000/year for premiums, and about $20,000-$40,000 roughly every other year in Advantage coverages.
I’m sorry but I don’t think the hassle of dealing with denials or having to start with a different treatment than your doctor prescribed and work your way up to the treatment your doctor actually wants just makes MA plans very unattractive. I had an HMO briefly, decades ago when I worked. My teenage son needed a pediatrician but the only in network doctor available in the very populated area where we lived was a gerontologist. My son ended up being denied a specific treatment he needed because the specialist thought the gerontologist should authorize it, and vice versa. I immediately switched back to a conventional BCBS plan and miraculously my son got the treatment he needed. If I wanted to deal with a bureaucracy I would have worked for the government. No thank you. Red tape doesn’t belong in healthcare to the extent MA plans use it as a tool to eventually deny care. I also find your repeated reference to the fact that this is an election year as an explanation for the negative headlines about MA plans undercuts your claims of objectivity regarding MA plans. Here’s your code word: Do you watch Fox a/k/a Faux News? Also, if supplement plans were free would you choose an MA plan for yourself?
Thank you for tuning in! This isn't meant to convince anyone to get an advantage plan. It's to help the 54% of Medicare beneficiaries on one know how they work. Supplement plans are great!
Also, your HMO plan pre-65 that is covering a family is not an advantage plan. Switching to a conventional BCBS plan means you still switched to a managed care plan - sounds like it is more like a PPO. There are PPO advantage plans as well.
Kind of sounds like you heard what you wanted to hear in the video. An election year is not the reason for the negative headlines. It is the reason for much more coverage around this topic than usual. These events happen every year - almost every month - in various parts of the country.
If a supplement plan were free, everyone would get it, but their not, and millions cannot afford them or do not want them.
For a supplement plan to become free, they would need to work like an advantage plan.
Hope that helps!
@@Theretirementnerds I am aware my pre-65 coverage was not an advantage plan. I had never had a managed care plan in my entire working life (I was a NJ public school teacher for decades) until
one year we were given a choice to try what the insurer itself called an HMO plan , and I decided to try it. It was managed care; maybe not exactly what an MA plan is today but it was the insurance company making my family’s health care decisions, which is the bottom line for advantage plans today. The BCBS plan was NOT a PPO. It was what used to be conventional insurance with the doctor and the patient having the final word, not the insurance company. As far as hearing what I wanted to hear- I merely repeated what you said at least twice in the video, and your saying it implied to me that you were intimating one party or the other was trying to make political bank out of it. I believe that you were trying to show a balanced view of MA plans, and gave context as to the scope of the hospital systems opting out. But here’s the thing- if systems opt out then patients often have to find new doctors as well as new medical facilities. I see 4 specialists and I cannot imagine having to change FIVE doctors. I read that a whole system somewhere in the Cascades opted out, which meant people had to travel many miles to another facility for healthcare. That’s not something elderly people should have to do. I don’t recall reading that hospital systems are opting out of original Medicare, so that’s another downside to MA plans, plus these plans are only for one year and their terms can change every year, which can be good or bad. Another downside is that once you have an MA plan, unless you can pass underwriting to get a supplement, you are stuck with an MA plan or just original Medicare, except in a few states. You’re stuck with the MA plan’s drug formulary as well. Lastly, MA insurers are incentivized by the federal government to deny care since they keep more government money when they do. I like your channel and I think you do a great job. I just felt the need to chime in. Thank you for responding to my comment.
@@mey7579 please know I welcome and appreciate all of these viewpoints. I agree with you on most of them as well. Given your health history and desire for network freedom, neither us nor anyone who would consult with you about Medicare should push you towards an advantage plan.
I think that's the biggest problem we have with things like Medicare call centers (private companies) that throw out commercials saying Advantage plans are better than OM and the call centers are pushing everyone, whether it's a fit or not, into advantage plans. Not explaining what we've explained in this video and others, nor what you've explained in your comment (we have videos that address these points in more detail).
I have a video I'm currently editing around the networks and systems dropping advantage plans. That isn't quite as dire as most are pitching it. It is a problem, though. That video also cites an election year as to why it is so publicized. Both sides use things like this to try and sway the senior voter base.
Hoping to post that one this weekend.
Politically, I can't stand either party on this issue, which is why I don't want to be connected, even loosely, with either :) Both make promises that never happen. Both have been "in power" to make changes and haven't. Both have made changes to the program that have ripple effects that end up hurting the Medicare beneficiary. I think a lot of the entities involved worry less about the beneficiaries and more about the insurance companies, drug manufacturers, PBMs, hospitals...
@@Theretirementnerds Great reply!!!
@@Theretirementnerds Another great reply!!!!
The info provided is nice. But I can tell this person has never worked with provider reimbusement plans. I hve seen them pay as low as 1.50 to a provider for services
Often times in those cases, the patient copay makes up the bulk of the charge, and the insurer is left with only a small obligation on their part.
You haven’t convinced me
Hi there! Not trying to convince anyone. Supplement plans are great! This video is for the 54% of Medicare-eligible Americans on an advantage plan :)
He's not trying to convince anyone of anything, he's explaining MA plans to people who have them or are considering them. He personally prefers Advantage plans, as he has made clear. Obviously you were not paying attention.
Your comment made my point
@douglasjensen8986 clarification... i personally prefer whatever plan is best for the individual 😊
If everyone could afford a supplement plan, I'd want everyone on it. For those who can't or don't want one, an advantage plan is a good option.
My mom had a supplement. My dad has Advantage. They both picked them, knowing full well what each entails.
@@Theretirementnerds Yes. By "personal" I was referring to what you would prefer for yourself.
More than 500,000 Americans are scheduled to lose their Medicare Advantage plans now that major insurer Humana is leaving 13 markets across the country. It seems the might have been something worth mentioning
I have an entire video dedicated to that 🙂
Recorded it today. Hoping to finish editing it asap
They will be given the option to select another Advantage policy in their area.
@@Theretirementnerds Thanks. I enjoy you videos. Some quick research showed the commission a broker makes for a MA plan would be approx $611 on the initial sale and 1/2 upon renewal. So, $ 916 in 2 years. My Plan G commission yielded my agent approx $223 for the 1st year and $186 for year 2. Approx total of $409. I do think you are honest and forthright, but that is a huge incentive for a less ethical representative to push MA. As you state, no one plan is right for all. My best friend is on a MA plan and is very happy. Thanks for your work. p.s. What does the fox say?
@tomt.9843 haha! don't let my kids see that... 🦊
Yes, I 100% agree there is an incentive there. Before 2025, one thing to remember on the supplement plan side is many people will also get dental, vision, and a drug plan with the supplement plan side that also have commissions tied to them. While small, they do close the gap a little.
In 2025, many Part D plans are doing away with commissions.
A couple other conflicts to know (I've thought about doing a video on this):
1. Advantage companies have the higher commission. Supplement plan companies, dental, and other ancillary plans can offer incentive trips. Put enough business with them, and get an all-expense paid, 10-day trip to Bali with your spouse(as an example).
The service burden on those who only do supplement plans with no drug help is remarkably lower than advantage or those who do help with Part D. There are many who will just do supplement plans with one insurance company (that does incentive trips) tells the client to figure out Part D and hopes they never hear from the client again.
So... there are incentives to both directions.
Our philosophy - Do what's best for the individual. If a supplement is the best fit, help them with that supplement. While the commission is less, if they are happy and refer their spouse, neighbor, friends... that's better than forcing someone on an advantage plan for that higher commission, they are unhappy, and don't refer their friends/family.
Each happy client ends up bringing 5-10 referrals, and that's how solid agencies end up growing ethically I think.
That was long... sorry about that.
They can enroll in another Advantage plan, or use their Guaranteed Issue Rights to enroll in original Medicare with a Supplement, which they are eligible to do since their Advantage plan is being discontinued.
Fox
Thank you so much! 🦊
Fox
Thank you! 🦊
Fox
Thank you! 🦊